Contact Stomatitis 

  • Author: Antonella Tosti, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 18, 2012
 

Background

Contact stomatitis describes an inflammatory reaction of the oral mucosa by contact with irritants or allergens (see the images below). Contact stomatitis is classified by its clinical features, pattern of distribution, or etiologic factors. Contact stomatitis frequently goes undetected because of the scarcity of clinical signs that are often less pronounced than subjective symptoms.

Irritant contact stomatitis of the tongue. Irritant contact stomatitis of the tongue. Close-up view of irritant contact stomatitis of thClose-up view of irritant contact stomatitis of the tongue.
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Pathophysiology

The oral mucosa is relatively resistant to irritants and allergens due to the following anatomical and physiological factors:

  • High vascularization that favors absorption and prevents prolonged contact with allergens
  • Low density of Langerhans cells and T lymphocytes
  • Dilution of irritants and allergens by saliva that also buffers alkaline compounds
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Epidemiology

Frequency

United States

The exact incidence of contact stomatitis is unknown; however, numerous well-documented series of patients with this disorder are described in the literature. Irritant reactions appear to be more common than allergic reactions.

International

In Europe, an estimated 0.01% of the population has oral symptoms related to dental materials.[1] Patch testing identifies a contact allergy in no more than 10% of these patients. Allergic reactions are usually intraoral (68%), and responsible materials are more commonly latex, metals, resins, and hygiene products. Patients with oral mucosal diseases are significantly more likely to have demonstrable hypersensitivity to food additives, especially benzoic acid, and perfumes and flavorings, especially cinnamaldehyde, compared with controls.[2]

Mortality/Morbidity

Contact stomatitis usually resolves without sequelae.

Sex

No sexual predilection is known for contact stomatitis, except for the burning mouth syndrome that almost exclusively affects women.

Age

Contact stomatitis may occur in persons of any age, but it is much more common in elderly individuals. A study evaluating oral lesions among elderly people revealed denture-induced stomatitis in 17.2% of patients aged 65-99 years.[3] Allergic contact stomatitis to nickel seems to be more frequent in young females with a clinical history of allergies; it is not associated with how long the patients are exposed to fixed orthodontic appliances.

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Contributor Information and Disclosures
Author

Antonella Tosti, MD  Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Antonella Tosti, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Dermatology Association, European Academy of Dermatology and Venereology, International Society of Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Massimiliano Pazzaglia, MD  Fellow, PhD, Department of Dermatology, University of Bologna, Italy

Disclosure: Nothing to disclose.

Bianca Maria Piraccini, MD, PhD  Director of Outpatient Consultation for Hair and Nail Disorders, Researcher, Department of Dermatology, University of Bologna, Italy

Bianca Maria Piraccini, MD, PhD is a member of the following medical societies: American Academy of Dermatology and European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Irritant contact stomatitis of the tongue.
Close-up view of irritant contact stomatitis of the tongue.
Acute allergic stomatitis involving the oral mucosa and the lip due to benzocaine.
Allergic contact dermatitis involving the lips and the perioral area due to propolis.
Allergic contact reaction due to nickel in a dental brace.
Allergic contact stomatitis on the gingiva in a patient with a positive patch test result to nickel, palladium, and mercury.
Leukoplakialike lesion in a patient who is allergic to mercury.
Lichen planus–like lesion adjacent to a dental restoration.
Contact urticaria of the lip due to food allergy.
Contact urticaria of the tongue in a patient with latex allergy.
Close-up view of contact urticaria of the tongue in a patient with latex allergy.
Positive patch test result to mercury.
Positive prick test result to latex.
 
 
 
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